Provider Demographics
NPI:1386045672
Name:FORD, ROI D III
Entity Type:Individual
Prefix:MR
First Name:ROI
Middle Name:D
Last Name:FORD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 WILD GINGER LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6002
Mailing Address - Country:US
Mailing Address - Phone:702-806-9594
Mailing Address - Fax:
Practice Address - Street 1:2424 WILD GINGER LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6002
Practice Address - Country:US
Practice Address - Phone:702-806-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner